18D-004 (5) 10. Do any signs exist on the property? YES X NO
IF YES, describe size, type and location:s�IL a.— _1hs:�IL��1ry ArplroX Are there any proposed changes to or additions of signs intended for the property? YES - !\
IF YES, describe size, type and location: % -_ � _ c.? / ' f _ }, `1
11. ALL INFORMATION ION MUST 13E COMPLETED, or PERMIT CAN BE DENIED
DUE TO LACK OF INFORMATION. This colnInn to Pc filled in
by the Building Depart.
EXISTING ! PROPOSED
REQUIRED BY
T — — ZONING
Lot Size 2.0 Acres 2.0 Acres
Frontage
179.71 179.71
Setbacks Front
Side L: R: L: R: L: R:
will remain
Rear the same
Building Height 1 story front 1 1 story front I
2 story rear 2 story rear
Building Square Footage
--r
4,382 4,•82
Open Space: (lot area 4 j
minus building & paved parking
# of Parking Spaces
15 15
# of Loading Docks
- 0 - - 0 -
Fill:
(volume Et location)
12. Certification: I hereby certify that the information contained herein is true and accurate to the best of
my knowledge.
Date:. - -- Applicant' s Signature
�O TE_ Issuance of a zoning permit does not relieve an applicant's burden to comply with all zoning requirements and obtain all
required permits from the Board of Health, Conservation Commission, Historic and Architectural Boards, Department
Public Works and other applicable permit granting authoriti
file (). o. I N i r" 2QOs
I ZONING PER1MMIT 1PPLICA ON_( §.1 Q.2),
PIcase type or print all information and return this form to the 'Sttildin g Tiispector's Office with r)lL
$10. filing fee (check or t ioney Ucryable to the City of Northctinritor'
/
1 . lal,7e of Applicant: / ` /[__ _ - "_ • . f.", /___ • C ✓/ - •
Address: J (: 1L! � (�/ /(� // 4 = ////7 G Y( j Telephone: / //Y
2. Owner of Property:__ -- William & Evelyn Mock _---------- .- - - - -__
106 Damon Road
Address: _ - _._ -- Northampton, MA. 01060 i eiephorle: 575 -6207
3. Status of Applicant: Owner Contract Purchaser Lessee X Other (explain)
-1. Job Location:_ -- /C ✓� ` /77C //G 1 (�
i /
Parcel Id: Zo � ! Parcel# _7 Distr
in. Elm Street District In Central Business District
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5 Existing Use of Structure /Property: Currently vacant
6. Description of Proposed Use /Work /Project /Occupation: (Use additional sfieets if necessary):
/ - ` r / ! i /
i � ' J 6 7
7. Attached Plans: Sketch Plan x Site Plan Engineered /Surveyed Plans
8. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO _ DON'T KNOW x 7 ES IF YES, date issued: •
IF YES: Was the permit recorded at the Registry of Deeus?
r In DON'T KNOW X r'ES
IF YES enref Book =- d illi!),' DOC 1_,111c7:1
`; f„he site contain a brook, body of water NI() _ DUN'T KNOW
i1 YES has a permit been or need to be obtained from the Cor,ser (1 mniisson:
lecd
s to be obtained t bi-aneC - - - - -- __ -- ,date issued: ---- ____ --
(Form Continues On Other• Si. : •)
File # MP -200 -0096
APPLICANT /CONTACT PERSON SIERRA RESTAURANT HOLDINGS INC
ADDRESS /PHONE 140 OLD ENFIELD RD (413) 478 -0030
5.. r
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
/ � ONING FO ► FILLED OUT
lee ad »S o —
Building Permit Filled out
Fee Paid
Typeof Construction: ZPA - OPERATE TAKE OUT /TO GO FOOD BUSINESS
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
Approved Ldditional permits required (see below)
PLANNING BOARD PERMIT REQUIRED UNDER : § _ C 2 ) /a/ i/.3
Interniediate Project : Site Plan AND /OR Special Permit with Site Plan
Major Project: Site Plan AND /OR _ Special Permit with Site Plan 4A ,,,?
esc
ZONING BOARD PERMIT REQUIRED UNDER: § aiKir-i SO
Finding Special Pen Variance* N �° S t
S.epfTE
Received & Recorded at Registry of Deeds Proof Enclosed _ SZeroTeR'm�'T
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health _ Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street C . ssion
Signature of Building Official Date
Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health, Conservation Commission, Department
of public works and other applicable permit granting authorities.
* Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact the Office of
Planning & Development for more information.